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HIV Vaccine May Cut Infection Rate

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Posted on Sep 24, 2009
HIV Vaccine
nature.com

Col. Jerome Kim, who helped to lead the $105-million study for the U.S. Army, said it was “the first evidence that we could have a safe and effective preventive vaccine.”

After almost 30 years since HIV surfaced in the United States, researchers in Thailand and the U.S. have created an experimental vaccine that has, over a seven-year study, been found to reduce the risk of contracting HIV by one-third. The vaccine is a combination of two existing vaccinations that were not successful in reducing infection.  —JCL

The Guardian:

An experimental HIV vaccine has for the first time cut the risk of infection, researchers say.

A medical trial in Thailand has raised hopes of a major breakthrough in the fight against Aids after scientists said an experimental vaccine had reduced the risk of HIV infection by a third.

The world’s largest HIV/Aids vaccine trial of more than 16,000 volunteers was the first in which infection has been prevented, according to the US army, which sponsored the trial with the National Institute of Allergy and Infectious Diseases.

A combination of two vaccines was tested on HIV-negative Thai men and women aged 18 to 30 at average risk of becoming infected. All the volunteers were given counselling and condoms to help them avoid HIV. Then half were randomly picked to receive the vaccine, while the other half got dummy shots. Until the trial ended, nobody knew who had been given the genuine vaccine and who had not.

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By GeorgeM, September 25, 2009 at 4:12 am Link to this comment
(Unregistered commenter)

I believe this is horrible hype. The VERY low rate of infection in either arm means that the ABSOLUTE risk is very low, less than 1%. The difference of 32% thus is based on differences at the level of less than 1%, meaning 99% of people would receive a vaccine and see no benefit.

There are further issues.
1) Why is the incidence of HIV so low (less than 1%) in the placebo group if it is higher generally (or in specific populations like) in Thailand?

2) According to this article:
http://www.aidsmap.com/en/news/FC15FEF3-3CA0-41F5-A4BF-72C145D583A2.asp
...but the confidence intervals for the estimate in the reduction in risk were wide (p=0.039, 95% confidence interval 1.1% - 51.1%).
—If there were some differences in baseline randomization with a few more higher risk individuals in the placebo arm, for example, the lower bound of the CI would go negative, wiping out the weak statistical significance.

3) We will not know about adverse events over the longer term.

My biggest worry is that the Pentagon is trying to justify wasting $150 million after many told them they thought this was a waste of time, money and lives. It may mean further investigation in these type of vaccines while more promising versions languish—based on lies produced by statistics ignoring the limited clinical relevance of such tiny absolute risk reduction.

Once again, the media have failed us. And the war against HIV is potentially derailed. The one bit of GOOD news is that the overall incidence WAS low—to my mind indicating that the trial design itself may have contributed substantially to a lower HIV incidence…i.e., access to condoms, clean needles, and ROBUST EDUCATION serve as more effective and safer means to reduce the spread of HIV disease.

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